Where there is no brain imaging: Safety and diagnostic value of lumbar puncture in patients with neurological disorders in a rural hospital of Central Africa

Mukendi, Déby; Kalo, Jean-Roger Lilo; Kayembe, Tharcisse; Lutumba, Pascal; Barbé, Barbara; Gillet, Philippe; Jacobs, Jan; Yansouni, Cédric P.; Chappuis, François; Verdonck, Kristien; Boelaert, Marleen; Winkler, Andrea Sylvia; Bottieau, Emmanuel

doi:10.1016/j.jns.2018.08.004

Cited by 17 publications

(11 citation statements)

References 28 publications

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“…In a case series at a hospital in rural Congo, 307 consecutive patients with LP were treated with a complication rate of 7.5%, namely, headaches, back pain, and confusion. All side effects were transient in nature, and no permanent damage was observed [ 125 ].…”

Section: Diagnostic Lumbar Puncturementioning

confidence: 99%

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Tumani

Petereit²,

Gerritzen³

et al. 2020

Neurol. Res. Pract.

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Introduction: Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): 1. The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient. 2. Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult. 3. In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF analysis program can be carried out within 2 h. 4. The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy. 5. As a quality assurance measure in CSF analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF analysis.

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Section: Diagnostic Lumbar Puncturementioning

confidence: 99%

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Tumani

Petereit²,

Gerritzen³

et al. 2020

Neurol. Res. Pract.

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“…[1][2][3] Although detailed history-taking and a neurological examination form the basis for an accurate diagnosis of headache disorders, neuroimaging is a critical tool in headache clinical practice when brain imaging facilities are available. 4 However, financial restrictions and exposure to radiation prevent routine neuroimaging being performed in every patient who presents with headache. 5 Several guidelines discourage routine neuroimaging in patients with migraine or chronic headache due to a low yield found in previous studies.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

Kim

et al. 2020

J Clin Neurol

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Background and Purpose Deciding whether or not to perform neuroimaging in primary headache is a dilemma for headache physicians. The aim of this study was to identify clinical predictors of incidental neuroimaging abnormalities in new patients with primary headache disorders. Methods This cross-sectional study was based on a prospective multicenter headache registry, and it classified 1,627 consecutive first-visit headache patients according to the third edition (beta version) of the International Classification of Headache Disorders (ICHD-3β). Primary headache patients who underwent neuroimaging were finally enrolled in the analysis. Serious intracranial pathology was defined as serious neuroimaging abnormalities with a high degree of medical urgency. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with incidental neuroimaging abnormalities. Results Neuroimaging abnormalities were present in 170 (18.3%) of 927 eligible patients. In multivariable analysis, age ≥40 years [multivariable-adjusted odds ratio (aOR)=3.37, 95% CI=2.07-6.83], male sex (aOR=1.61, 95% CI=1.12-2.32), and age ≥50 years at headache onset (aOR=1.86, 95% CI=1.24-2.78) were associated with neuroimaging abnormalities. In univariable analyses, age ≥40 years was the only independent variable associated with serious neuroimaging abnormalities (OR=3.37, 95% CI=1.17-9.66), which were found in 34 patients (3.6%). These associations did not change after further adjustment for neuroimaging modality. Conclusions Incidental neuroimaging abnormalities were common and varied in a primary headache diagnosis. A small proportion of the patients incidentally had serious neuroimaging abnormalities, and they were predicted by age ≥40 years. These findings can be used to guide the performing of neuroimaging in primary headache disorders.

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“…This exploratory study has many limitations, most of which were largely acknowledged in previous publications [14,20,21]. The use of patients rather than a sample of the general population is one of the limitations of the study as it does not enable the magnitude of the underlying problem to be estimated.…”

Section: Discussionmentioning

confidence: 99%

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

Mukendi

Kalo

Lutumba

et al. 2020

Preprint

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Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium , is not well known in the Democratic Republic of Congo (DRC). As part of an etiological study, we consecutively evaluated from 2012 to 2016 all patients older than 5 years admitted for neurological disorders (neurology cohort) at the rural hospital of Mosango, province of Kwilu, DRC. No neuroimaging was available. A similar study was conducted among patients presenting with persistent fever (> 7 days) during the same period in the same hospital. In both studies, etiological diagnosis relied on a systematic set of reference laboratory assays and on pre-established clinical case definitions. The aim of this post-hoc analysis was to determine the frequency of T. solium infection in these neurology and persistent fever cohorts and to explore its association with specific neurological presentations and final etiological diagnoses. Methods We conducted a descriptive and analytic study between the group of neurological syndrome patients and persistent fever based on the presence or not the cysticercosis IgG using the B158/B60 enzyme-linked immunosorbent assay and of the LDBIO Cysticercosis Western Blot IgG assay, respectively.. Results For the neurology cohort, 340 samples (of 351 enrolled patients) were available for analysis (males: 46.8%; mean age: 38.9 years). T. solium antigen positivity was found in 43 participants (12.6%; 95% confidence interval [CI] 9.3-16.7%), including 9 of 60 (15%) patients with epilepsy. Of the 148 evaluated samples from the persistent fever cohort (males: 39.9%; mean age: 19.9 years), 7 had positive T. solium antigen (4.7%; 95% CI 1.9-9.5%; P=0.009 when compared to the neurology cohort). No significant association was found within the neurology cohort between positivity and clinical presentation or final diagnoses. Of note, the antibody-based assay was found positive in only four (1.3%) of the participants of the neurology cohort and in none of the persistent fever cohort. Conclusions T. solium antigen positivity was frequent in patients admitted with neurological disorders in the Kwilu province, DRC. Further neuroimaging studies should explore whether neurocysticercosis is prevalent in this region.

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Where there is no brain imaging: Safety and diagnostic value of lumbar puncture in patients with neurological disorders in a rural hospital of Central Africa

Cited by 17 publications

References 28 publications

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

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